CDC Unveils Updated Set of Opioid Prescription Guidelines

After six years, the CDC released its latest updated guidelines regarding prescribing opioids for pain management. The newest guidance builds on new evidence gathered since 2016. It highlights the benefits and risks of opioid prescriptions, comparisons with non-opioid treatments, risk mitigation strategies, and, most importantly, opioid tapering and discontinuation. 

Guidance on Tapering and Discontinuing Opioids

One of the main takeaways from the new set of guidelines is the need to properly decrease dosage and taper patients off to provide tolerable opioid discontinuation. The CDC’s guidelines frequently referenced the Health and Human Services (HHS) Guide for Clinicians on the Appropriate Dosage Reduction or Discontinuation of Long-Term Opioid Analgesics. 

The HHS guide warns of the possible side effects of rapidly tapering or suddenly discontinuing opioids in physically dependent patients. Some concerns include acute withdrawal symptoms, psychological distress, and suicidal thoughts. Patients taken off prescription opioids too quickly may also search for illicit opioids to fill the void, which is very dangerous because unregulated drugs may contain unknown and hazardous substances. 

The CDC guide recommends clinicians consider altering or discontinuing opioid prescriptions when a patient asks for it, when pain management improves, if higher dosages do not provide any benefit, and for many other patient-specific reasons. The guidance also emphasizes that clinicians should consider changing the course of a prescription when the risks outweigh the benefits. For example, many other medications, like benzodiazepines, are dangerous to take alongside opioids. Certain medical conditions also pose issues with opioid use, like sleep apnea and liver and kidney disease.

Guidance on tapering from the CDC echoed that of the HHS, which recommends slow tapering for most patients. The HHS said that the longer a patient uses opioids, the longer the tapering may take. Depending on the duration of a patient’s opioid use and their current dosage, tapering can take months or even years when diminishing doses at 10% or slower each month.

Discontinuing or reducing opioid prescriptions can be difficult for both clinicians and patients, but it is a crucial consideration for the long-term safety of patients. However, tapering and discontinuing are only part of the equation when prescribing opioids. There are many other factors for clinicians to consider when administering opioid prescriptions. 

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Additional Elements for Prescribing Opioids

The CDC’s guidance focuses on pain management for acute (less than one month), subacute (one to three months), and chronic (greater than three months) pain but does not include guidance for pain management associated with sickle cell disease, cancer, or end-of-life care. 

Determining dosages and prescription durations is one of the most important preliminary steps for clinicians considering prescribing opioids. Some pertinent points from the guidance include not prescribing more than a patient may need and instead reevaluating a patient’s needs every few weeks. The CDC also said that clinicians should discuss tapering strategies with patients for short-term pain management to ensure safe discontinuation. 

For long-term opioid prescriptions for issues like trauma care, the CDC said clinicians should consistently follow up with patients to avoid escalation risks like opioid dependence and opioid use disorder. If a patient shows signs of escalation risks, the CDC urges clinicians to begin discussing tapering and discontinuation or non-opioid alternatives that may substitute opioids. 

The 100-page document details a plethora of opioid prescription considerations, building on the guidance released in 2016. The most major additions include tapering and discontinuation guidance based on new evidence collected since the last update. 

Author

Reed Slater

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